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Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) Application in Massive HCC Patients with Liver Cirrhosis
26 Pages Posted: 8 Dec 2022
More...Abstract
Background: Associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS) application in cirrhosis-related hepatocellular carcinoma (HCC), especially severe cirrhosis, remain scarce. This study was to explore the feasibility and efficacy of ALPPS in HCC patients with liver cirrhosis.
Methods: From August 2013 to September 2022, 72 patients with massive HCC were involved. The Laennec scoring system was used to assess the severity of cirrhosis. Additional adjuvant therapy was introduced after stage-1 ALPPS if the remnant liver could not reach sufficient hypertrophy in short period.
Results: 25 patients were non-cirrhosis (S0-2, n = 11; S3, n = 14), and 47 patients had different stage of cirrhosis (S4A, n = 18; S4B, n = 20; S4C, n = 9). The ALPPS completion rate for stage 0-2, 3, 4A, 4B and 4C patients, were 100%, 85.7%, 83.3%, 65% and 33.3%, respectively. The median number of days required between the two stages was also significantly prolonged with the aggravation of liver cirrhosis. The 1-, 3-, and 5-year overall survival rates for completed ALPPS were 80.7%, 56.9% and 50.5%, respectively. Due to the relatively long waiting time for stage-2 procedure, 36 patients (50%) received adjuvant therapy after stage-1; among that, 21 patients (58.3%) finally completed the ALPPS after more than 1 month interval. Additional therapy after the first stage ALPPS significantly improved survival outcome before and after PSM analysis.
Conclusions: ALPPS is feasible for patients with fibrosis or mild liver cirrhosis (stage 0-4A). For unresectable HCC patients with moderate to severe cirrhosis (stage 4B and 4C), ALPPS may provide better prognosis combined with other treatments during waiting period.
Funding Information: This work was supported by the National Natural Science Foundation of China (No. 81702404 and 82172611), and the Natural Science Foundation of Guangdong Province, China (No. 2017A030313536 and 2022A1515012205).
Declaration of Interests: The authors have no conflicts of interest to declare.
Ethics Approval Statement: The application of the ALPPS technique was approved by the Ethics Committee of Sun Yat-Sen Memorial Hospital and the research was retrospectively registered. Informed consent was obtained from all patients before the procedure.
Keywords: ALPPS, Hepatocellular carcinoma, Fibrosis, Cirrhosis, Conversion therapy
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